Male sex hormone system: how it works, testosterone, low T symptoms, TRT, and more | Peter Attia
Вставка
- Опубліковано 7 лют 2025
- Peter provides a comprehensive overview of the male sex hormones. This video is a segment from The Drive podcast Episode 256 - The endocrine system: exploring thyroid, adrenal, and sex hormones. The full video can be found here: • 256 ‒ The endocrine sy...
Watch the full episode and view show notes here: bit.ly/432u3eB
Become a member to receive exclusive content: peterattiamd.c...
Sign up to receive Peter's email newsletter: peterattiamd.c...
--------
About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 60 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
Learn more: peterattiamd.com
Connect with Peter on:
Facebook: bit.ly/PeterAtt...
Twitter: bit.ly/PeterAtt...
Instagram: bit.ly/PeterAtt...
Subscribe to The Drive:
Apple Podcast: bit.ly/TheDrive...
Overcast: bit.ly/TheDrive...
Spotify: bit.ly/TheDrive...
Google Podcasts: bit.ly/TheDrive...
Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies.
![Taurine: The Nutrient of Youth [Science Explained]](/img/n.gif)
This information is great, I'm so happy that content like this is free
Been needing an overview like this. Thanks Dr. Attia.
One of the best videos on the topic if not the best 👏👏👏
"I didn't need to draw two of them "...the hell you didn't
If you drew 1 only, would that be the left or the right ? You should also consider to draw 3next time, for better understanding.
Yall funny asf
He gave them wrinkles and hair too
I've been looking for something exactly like this. Thank you, Dr. Attia!
Brilliant summation for the average person trying to understand this process 👍
I was on TRT for 5 years and it caused me heart arrhythmia and finally stopped.
Years later I fixed my sleep apnea and my testosterone shot up.
Now I'm 70 and have very good testosterone levels.
What are your testosterone levels ?
@@Leamoyersince I solved my light apnea problem my testosterone levels are basically normal and with good erections
that never happened.
This is the clearest video I've ever seen on testosterone in men. Bravo and thank you.
I've been looking into TRT for well over a year, waiting because of the lifetime cost and getting my thyroid levels right first. I have symptoms: near zero libido, fatigue, "oomph". Recent blood results show improved free T perhaps as result of increasing my activity level a lot. Next is to introduce resistance training alongside running and swimming.
Thanks again. Subscribed.
Thank you, Peter. This was super helpful. I'm debating whether or not to start TRT and I feel much more informed now and ready to take action. Keep these videos coming!
Excellent one of the best explanations of this system Ive seen. I would like to know what you think about fasting and its affect on SHBG and androgen receptor sensivity. Also what are your thoughts on Enclomiphene instead of clomid? Thanks dr attia!
Great question, I would also like to know his thoughts on enclomiphene.
I am 60 years old, have never HRT; my total testosterone is in the 700s with normal free and available.
My estradiol is very low; a high sensitivity test shows it to be 10 pg/ml. I am having symptoms that may be related.
My question, do some men aromatize poorly and if so is estradiol ever supplemented?
Great video. Thanks for being clear and concise.
I think the subtle role of progesterone in men is important and like in women it counteracts the anabolic effects of the stimulating growth effects of estrogen on the cells. Men like women today are stressed leading to lower progesterone causing relative estrogen dominance and the potential for consequences perhaps of cell proliferation and it’s role in prostate cancer. Would love your thoughts Peter? Super helpful videos. Thank you
Ridiculously good summary. (Im a physician also)
It's good to see a doctor that gets it right.
1. First do no harm.
2. The patient matters, not the numbers.
@Peter Attia MD I think you should address the primary vs secondary hypogonadism as a fundamental underlying need for TRT in the first place and how these two diagnoses differ. The American Association of Clinical Endocrinologists is a good source . Also, I am surprised that you did not explain the two isomers found in clomid and the differences in their effects and effectiveness. Both clomid and enclomiphene are being prescribed under the umbrella of TRT.
I think it’s more of a sensitivity to DHT at the follicle rather than hyper active 5aR which contributes to hair loss hence there’s a pattern.
Impressive and Spectacular
Dr. Attia - you say something which isn’t very clear to me here, essentially at the end, you say you try them on TRT for 8 to 12 weeks to see what the results are, and then make a decision if it makes sense to continue or not. From my understanding, it’s not a “try and see thing?” From everything I’ve read it’s not a try and see thing as 8 to 12 weeks seems to be enough time to shut down natural production. What kind of post-cycle therapy are you doing at the end of 8 to 12 weeks if you or the patient decides it’s not for them?
Also, you mentioned permanent shutdown of natural, but most things I’ve read from other doctors are saying that in their experience, it usually always comes back to pre TRT levels , even though it takes time.
The HCG injections was briefly touched but it sounds like the best option. Why was he so quick to dismiss? I would like to know much more about that. Sounds you can increase your testosterone without affecting the testes from permanently shutting down
Great video Doc, Can you do a video on a natural supplements you can take to boots you LH, FSH ? Thanks
the idea of supplements "boosting" anything is pseudoscience
Hit like before I watched. The research behind TRT is so lacking.
Amazing explanation!
Please invite Wim Hof as a guest Peter.
11:18 if you hair follicles arent heredictly susceptible to DHT it doesnt matter how much DHT you have. You can take tons of T and still have perfect hair, but if your hair is susceptible to DHT even taking TRT and you can say your hair good for good. Finasteride may slower it a bit, dudasteride even more but dudasteride is.. well, very bad side effects.
Peter why would clomid, better enclomiphene be bad by surpressing estrogen ? The folks having hypogodnadism, have too much estrogen anyways, thus this would work synergistically.
What if LH was constantly above the normal range, while Total and Free T were in normal ranges. What does this signify?
What would you do if symptoms improved on TRT so they went off it after 3 months as you mentioned and got worse again after going off TRT?
Is this a trick question? Go back on in think.
good video
You forgot to specify which replacement therapy you recommend as a starting point.
Can you please deliver information on major mood disorders including BP1, 2, and cyclothymia. Some approaches, vitamins, and methods can cause issue. Anything to move the conversation forward as these people must live their lives too
damn that was a great overview. What about a 65 year old male patient who has a rotator cuff injury that was allowed to linger for a couple of years and is now considering surgical repair. Given the difficulty of building muscle in that age group and the scar tissue issue.....why not provide a short or medium term round of testosterone to help facilitate this healing process in a reasonable amount of time.
does any one do this?
I am similar age and had rotor cuff open surgery 9 months ago. BPC-157 and TB500 has accelerated healing
I think being on complete replacement TRT for 12 years probably means that HCG and FSH treatment won't be able to stimulate the testicles again ! Well, that sucks !
You should do a lecture on unexplained lethargy and muscle atrophy with lab values @
Total testosterone - 910
Free testosterone - 1 %
SHBG - 88
BMI - 15
Stress
@@Kushgroove234 I could definitely see and agree how stress would be tied to lethargy but how could stress cause muscle wasting resulting in extreme weight loss and 1% free testosterone ?
@@no_country_for_real_men read up on it, cortisol is catabolic and impedes your abilities body to rest and gain muscle
Stress has very clears signs of physical affects on the body
Life stresses and chronically high stresses are subtle but cumulate over time.
For extreme examples look at photos of people before and after war
@@Kushgroove234 I have done years of extensive research on stress and I have never found anything tying muscle wasting and virtually non-existent free testosterone to it.
I had my cortisol levels checked 3 different ways (blood, urine & Cosytropin) and every test came back with low cortisol and yet my stress was at all times highs for 5 years straight.
@@no_country_for_real_men Assuming those are your numbers, and SHBG was in nmol/L, did you figure out why your SHBG was so high causing low free T?
Im 16, got my blood test back and I am at 280mg testosterone levels, that would explain why I am so depressed stressed out, didn’t grow anymore at the age of 14 and can’t build muscles. The question is what should I do, because taking test is definitely gonna improve my deteriorating health now but if I will be older will there be consequences? Please help idk what to do
What amounts of Free Testosterone would be considered low, medium, high?
Testosterone, Free, Calculated: Normal range = 7.0 - 36.7
A question I have had for many years is, how many men get TRT for libido, etc. compete in masters competitions? Do they know that they need a therapeutic use exemption from wada/USADA to use TRT? Do they know that just because a doctor prescribes TRT, that it doesn’t make it legal for competition? How many use testosterone and know that they’re doping and compete anyway? The proliferation of anti aging clinics and “Man” clinics and the exponential use of testosterone leads me to believe that there has to be doping in masters athletics from prescribed T and possibly other ergogenic meds. Please, if you’re using TRT, don’t compete.
I’ve been on TRT for over 6 years. This past year my libido disappeared, despite my total Testosterone being 1500. Any idea why this could have happened?
your estrogen and or prolactin are out of whack because of the high dose of TRT and or high aromatasition
@@Testty I had my estrodile checked in February and it was 13. My Testosterone was still pretty high then too around 900. Still didn’t have a sex drive. I’m on pellets currently until April. I may switch to cream then. Maybe that will help.
enclomiphene citrate is far superior to clomiphene... All the stimulating effects with none of the blockage of estrogen or bad sides
You mentioned reference ranges of bottom 30%, or something similar. What are the actual numbers, or where would we search rider what those numbers are?
I just recently was tested and found that my total testosterone was low (220) but my free testosterone was normal at 2.5%. Is this still considered low testosterone?
Yes mate very low.
Your calculated free testosterone is also low. Below 7 ng/dl is considered low. A combination of fasting and exercise will most likely increase it to normal range overtime.
I wonder if this would be beneficial for the elderly helping with quality of life with better strength from things like falling and be able to get up on there own .long term side effects don't matter much at this age .
Should definitely get levels checked. I started having low t in my late 20s
I think low testosterone is genetic. I’m in my late 40s, about 20% body fat, but I’m super active in the gym and in life. But my last test was over 750. I travel a lot, sleep is all over the place, I like to drink, I have a lot of stress, but for some reason, my testosterone is still high. I think SHBG is really where people need to focus. I doubt I will ever take TRT because I don’t have the symptoms of low T.
check your homocysteine
Watch out alcohol will catch up with you. At a lean 200 pounds I benched 315 from 19 to 51. Most of those years drinking and eating anything I wanted. It caught up with me and started taking muscle away from me. I am now alcohol and caffeine free and watch my whole food diet getting me back to where I am muscular and benching 255 at 56.
@@F_trump nice, I consistently bench 275-300, and squat 400. I’m 47. I ran a marathon last year. Skied Snowbird this year. Just hiked the Great Wall of China two weeks ago. I used to date a lot(divorced), no problems there. Love the cocktails and greasy food, but I need to slow down. I sleep well. Life’s an adventure.
“I sleep well.” … “My sleep is all over the place.” - You forgot to mention the bipolar issues. 😂
While there may be a genetic component to testosterone levels, various factors like lifestyle, sleep, stress, and alcohol can influence them. Your high testosterone levels could be attributed to your active lifestyle and healthy body fat percentage. It's important to consider SHBG's role in regulating testosterone availability. Since you don't have low testosterone symptoms, you may not need TRT. Consulting with a healthcare professional can provide personalized advice based on your situation.
Thank you for such great input, Peter. If a healthy male in his early twenties would report low libido and ED after taking a drug against hair loss, would that then probably be through blocking 5αr and bringing down DHT? If you shut-off 5αr, would this automatically lead to relatively higher conversion of T to E2 via aromatase? Or is this dependent on other factors than just inhibiting 5αr? TIA
I fit the profile too, being a healthy male in my mid 20s. Experiencing reduced libido, ED, premature ejaculation, and reduced testes size 1.5 months into 2.5mg of Finasteride daily. Has been a detriment to my relationship with my partner, so hoping the effects die down after at least several months into my hair loss treatment. Heard that there is a possibility that things may normalise later, otherwise, might stop its intake as we look into having children soon.
@@bgoodorhell4uWhat research? Reddit?
How would you treat ED with supplement and workout only ?
Unicorn horn powder
So Anastrozole in addition to Clomid will absolutely wreck your Estrogen feedback loop? Thats literally what every "boxed lunch" TRT clinic prescribes. "Never seen a case of gynecomastia in 10 years of prescribing testosterone"....that says everything!
What does it mean when LH and FSH are way higher than normal range?
High LH and FSH and low testosterone mean you’re balls is not working. Your brains is signaling but your nut is not responding. Primary hypogonadism.
However, taking men off TRT because a symptom such as ED hasn't improved yet can have terrible consequences for them as it's removing all hope.
The terrible effects on a marriage, along with the associated depression, shouldn't be underestimated.
Treatments such as Nebido injections shouldn't be viewed as easy solutions as they often are in the UK. It is very disappointing that medical science has no answers for such patients.
1-2 years on TRT shuts down test production entirely??? Seriously concerning... I'm 36 and have been on it for 1.5 years and my clinic definitely did not tell me that... Maybe I should look into HCG instead...
No, it most definitely does not do that. I really don't understand why he keeps pushing this narrative because it just simply isn't true.
awesoem
How low of level before you have to start TRT with out focusing on symptoms alone?
What if it's 250? 200? 170?
I'm curious when says that numbers can't be used alone
I suffered a prolactinoma almost 2" long almost compressing my optic chiasm, the tumor was reduced without surgery, only with a treatment with cabergoline, however after that I do not produce Luteinizing hormone (LH), and therefore I have very low testosterone levels, currently being treated with testosterone gel and it has gone well, but I would like to know if I can stimulate the production of LH. Thank you and regards.
Dr. Attia, I hear insulin sensitivity mentioned frequently and often hear I can expect it as someone who has Hashimotos. But what is the best way to test insulting resistance?
Hba1c..its your 90 days resting blood sugar
This is valuable for women too, as we can send this to the men in our family.
Hi Dr, what's your personal view on Finpecia and its effect on the hormonal system in men ?
The confusion for me was always the inability to put on muscle mass in my twenties but having a massive sex drive along with excess sebum production along with acne. I couldn't of been aromatasing excessively because I had no signs of gynecomastia or anything else that came with high estrogen levels. Perhaps I just had a fast metabolism?
What are your thoughts on using DHEA?
More importantly the safe dosage, and the time of day. I started on one with 100mg, and took it at night as recommended. I could not sleep for hours. But felt great. I’m in my mid 50s. I now take 50mg in the morning and feel fine. I miss the feeling I had taking it at night along with TMG, but I like sleep better. I may try 25mg twice a day, once in the morning, once at night. Taking DHEA has certainly increased my energy.
@@RogueCylon I take 50mg DHEA at night with dinner and I'm mid 50s as well. I didn't know that DHEA can cause sleep problems. I'll have to test that theory to see if it's actually affecting my sleep or not.
@@patricklachance6880 for some it causes insomnia. I just had great energy at night while taking it. So I would wake 2-3 times, and feel great, but wasn’t getting that deep sleep. Once I changed to morning, I got the energy throughout the day.
Can anyone weigh in? I’m a carpenter, working outside in the summer is tough to control hydration and replace salt lost from sweating. Per day I drink a 4L jug of water with a couple tablespoons of sea salt as well as a 2L jug of water with a few scoops of Gatorade powder. I’ve found this combination to be the best way for me to “feel” better at the end of a work day but am I screwing myself by taking in all that sugar in the Gatorade powder??
Lets find an electrolyte powder without sugar or with less sugar and no artificial colors or flavors. Can anybody suggest a replacement for the gatorade? I know they exist. I’ve even seen *organic Gatorade but haven’t read the label to see what’s in it. Also consider ones personal budget.
Make sure u are getting plenty of potassium too lots of ways to get it through fruit etc
Does high Albumin and SHBt mean you have less free testosterone?
I’m 23 years old and my testosterone is 298. I feel the symptoms of no lobido. can’t gain muscle mass. And just feel like I have no energy. Thinking about getting on clomid but everything is so wishy washy
My doctor wouldn’t treat me at 300. You’ll probably have to treat yourself like I do.
My doctor doesn’t think anything is wrong with me but I know there is. I am 4.10% free at 9.61 ng/dL so apparently I am way above the 1-3% free but my total is very low at 235ng/dL. My shbg is fairly low too 22.07nmol/L. He doesn’t want me to go on TRT or treat me at all. I feel like he’s minimizing my symptoms because he thinks I’m a young guy at 37 years old.
I wish you would do a deep dive on enclomiphene
ua-cam.com/video/8ezz7dfqjhg/v-deo.htmlsi=xvdX3oxPu7x7fm7i
Should I get some sort of T therapy ?
My free testosterone was measured to be 0,305 and the "normal" range were according to the test between 0,250 - 0,750.
My Albumin was bellow 5mg/l and my testosterone value was measured to be 16 and 17,55 nmol/l (it went up slightly after using ashwagandha)
I believe my T is on the low and I also have all the symptoms of low T, but I cant get helt because I am still above the borderline ...
I have been weight lifting since 2014 so ny testosterone issues are not a result of inactivity.
Any opinions on this would be interesting 👆
U think maybe u could just be overtraining? Those levels don't seem bad
@@bluedevils81 0,305 free T is close to borderline. Did you know they changed these accepted values recent years, and 30 years ago someone my age of 38y would be way above 0,400 maybe even around 0,500 free t?
They lovered the value spectrum because people are on average having lower and lower t levels. And I am pretty sure 30 years ago, someone with 0,300 free t levels would be the value for a male in his 60s🤷♂️
@@bluedevils81 regarding overtraining, i do like 3 hard workout days a week 4 different excorsizes with 4 sets on each, going each set to failure. And then 2 times a week with milder workout just to get some blood going and some smaller muscle groups working as well.
I have long periods with no issues and then suddenly i just lose all juice/mojo and my workouts become pure sjit and no energy at all for like several 2-4 weeks, and I dont have joint pains or injury so i doubt its overtraining.
Aromatised TESTOSTERONE to ESTROGEN is also the oestrogen that makes humans aggressive according to the research from David J. Anderson.
wonderful video!! 👏
from your experience… is there a way to increase your androger receptors so to be more “sensitive” to the drug?
i’ve heard someone speaking about carnitine to do so.. butnin high high amount (injectable basically)… can you inform us on this?
lowering stress and eat plant based foods would lower male sex hormones and likely increase the receptors , using same principles with glucose .
@@newdata yes.. but if it increase androgen receptors while lowering male sex hormone… what is the main point?!? 😄😄
i asked a way to increase androgen receptors while at least keep the androgen hormone at the same level!!😉
@@newdata You are saiyng that without stress and animal protein we men tend to have less sex hormone??
TRT doesn't solve the root cause of low T. I'd rather take Metformin if I developed Insulin resistance.
I have a testosterone score of 300 and my doctor keeps telling me that is completely ok. I feel the symptoms that Dr. Attia mentions. does anyone know if 300 test score is actually low?
At 300 and you're having symptoms? In my mind there is no doubt that you need to be on therapy you need to find another physician ASAP! Your doctor is totally out of touch they say as long as you're 300 you're great BS! Doctors really need to learn to treat symptoms rather than lab numbers....
How do I increase my free test? I have 725 total testosterone
Wha's ur free test?
98% of one's total testosterone is bound by Sex Hormone Binding Globulin.. and it's only the free Testosterone that can do the work of building bone density, muscle-mass, libido, Red-Blood-Cell production, etc.
So if one has a total Testosterone of 350-1200 ng/dl... due to SHBG, the Free Testosterone for men in there 20s is 10-20 ng/dl (depending on the lab)
BTW, SHBG is influenced by genetics, and goes up with higher levels of estradiol and T4... and higher with LOWER levels of Insulin.
Regarding T4.. if TSH stimulates the thyroid gland to produce inactive T4 (same as Synthroid ) and that too must be converted to T3 (by releasing an Iodine) in order to be active T3... why is SHBG affected by T4 and not T3?
If you want high IGF for brain heath, or if you just want to look like a 1983 Mr. Olympia (Samir Bannout), then you'd have to supplement 3g of Leucine in a meal or during an exercise* to stimulate MTOR and build muscle . Whey protein contains 10% leucine.. or get via Sigma Chemicals, Now Sports (made with Duck Feathers?), Jay Robb, BioSteel.
*Large muscle exercises of Pushing, Pulling, Hip-Hinging
37yo and I have 13,95 nmol/L (402 ng/dL) testosterone... can't figure out if it's low or normal...
edit: my free testosterone is 18,6 pg/mL
You're fine. Im 38. T level is 245. Free T is 12
@@emdieselify Do you feel OK? Libido fine?
@institorisinstitoris959 yeah, i find my libido fine. I want to have sex, wife and I had a baby so we gotta wait a few weeks before intercoursw
@@emdieselify Thank you for replies man, means a lot
@institorisinstitoris959 no problem. I think for my T levels to go back up, i need to quit drinking alcohol altogether. Im not even a big drinker either. I just think its bizarre that i live a healthy lifestyle for the most part and my T levels were that low. I guess we all got room for improvement and to better ourselves
Test shut off permanently after 1-2 years of TRT ??? You’re then expert, but I’ve heard/read countless times natural production will always bounce back, given the right amount of time
He is a bullshitter. It does bounce back IF the organism was healthy before starting. Many go on TRT because they have low T issue and when they stop they have low T issue. After using for long period of time it might take months to bounce back but it does given the right nutrition
I know a coworker was on it for a year and quite cold turkey and he’s still alive 😂😂. But he’s in his 30 s .
I don't know why he keeps saying this in his videos because it isn't even close to true. It just devalues everything else he says.
I only ate beef for a week and my testes felt like they were having a party
Can you comment on how modern dairy cows have been genetically modified to give milk while pregnant to increase yield? Apparently the amount of estrogen and progesterone skyrockets in todays milk supply because of this.
They have to be pregnant to produce milk..like, wutttt
@@indianamal710 They modified dairy cows so that now they can be pregnant while also producing milk. This significantly improves productivity. A Japanese study has shown that drinking milk from todays modern dairy cows reduces testosterone in males while increasing estrogen and progesterone. Maybe we should put less focus on soy and more on milk.
I currently found out i have low testosterone. What is the high FSH telling me?
Total - 190L
Free - 30.8L
FSH - 8.1 high
My sac
I don't think you're a real doctor.
I can read your writing...
Wait are your saying there’s a difference between men and women?!? 😅🤣
nofap or semen retention will help with most of the testosterone problems
🙈🙉🙊
Mercy I'm glad your not my Doc,to put someone on trt for 8wks then take them off,,, I guess your just practicing
This is not good advice. You really need to get a professional testosterone expert as my testosterone was 100 … it was up’s to 800 and it was not sufficient to get rid of my so-called symptoms and wasn’t until I hit 1200 with my free testosterone at 24 and my symptoms went away …. so stopping after 12 weeks could be the worst possible thing to do😊
👌good info